Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Addiction Research and Treatment, Inc. for Narcotic Treatment Program Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Addiction Research and Treatment, Inc. for narcotic treatment program services, for the term of June 1, 2025 through June 30, 2027, in an amount not to exceed $2,313,140.
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BACKGROUND:
Behavioral Health and Recovery Services (BHRS) launched the Drug Medi-Cal Organized Delivery System (DMC-ODS) in 2016, which greatly expanded the continuum of care and increased levels of care targeting Substance Use Disorders (SUD). BHRS is now part of CalAIM, a multi-year initiative by the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of its population by implementing a broad delivery system and program and payment reform across the Medi-Cal program. The behavioral health components of CalAIM are designed to support whole-person, integrated care; move the administration of Medi-Cal behavioral health to a more consistent and seamless system by reducing complexity and increasing flexibility; and improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through improvements to behavioral health policies and the launch of behavioral health payment reform.
In January 2024, BHRS conducted a Request for Proposals process for DMC-ODS Narcotic Treatment services. Addiction Research and Treatment, Inc. (ART) responded and was recommended to provide these services based on their over 40 years of community experience and their detailed service, staffing, and training recommendations.
DISCUSSION:
The demand for Medications for Addiction Treatment (which includes Narcotic Treatment Program (NTP) services) has increased significantly because of the opioid overdose epidemic. Additionally, service access has been expanded due to San Mateo County’s successful implementation of the Affordable Care Act, the expansion of Medi-Cal eligibility due to CalAIM, and the expansion of benefits under the DMC-ODS.
Through this agreement, ART will operate and manage NTP services for San Mateo County adult Medi-Cal clients and adult clients that are not eligible for Drug Medi-Cal or other health care insurance with complex needs. These services include assessment, care coordination, individual counseling, group counseling, family therapy, medical psychotherapy, medication services, Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD), MAT for Alcohol Use Disorder and other non-opioid SUD, patient education, recovery services, and SUD crisis intervention services. Research has validated the effectiveness of methadone treatment for patients with OUD.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
Success for services under this agreement is measured by sustained abstinence over a one-year period and is verified by a rigorous regime of testing for alcohol, methadone, methadone metabolites, heroin, opium, other opioids, cocaine, amphetamine, methamphetamine, and other substances. Each patient is randomly tested once a month. It is anticipated that 90% of clients requesting methadone services will receive treatment within 24 hours.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Actual |
FY 2024-25 Estimated |
|
Percentage of clients requesting methadone services that receive treatment within 24 hours |
90% 174 of 194 clients |
95% 148 of 156 clients |
COMMUNITY IMPACT:
This contract will positively impact the behavioral health of low-income residents in need of SUD treatment services. Outpatient NTP providers offer bilingual and bicultural substance use treatment services in convenient locations across San Mateo County with the aim of helping residents to achieve long-term wellness and recovery. These SUD providers are essential to assure equitable access to quality care for underserved and vulnerable people in San Mateo County. Most clients have co-occurring mental health needs and other complex needs, including homelessness, justice system involvement, and other physical health conditions.
To advance health equity, improve quality, and help eliminate health disparities, the County requires providers to comply with National Culturally and Linguistically Appropriate Services standards. Each provider is required to submit an annual cultural competence plan that details current and future efforts to address the diverse needs of clients, families, and the workforce in San Mateo County.
FISCAL IMPACT:
The term of the agreement is June 1, 2025, through June 30, 2027. The amount of the agreement is not to exceed $2,313,140 for the two-year term. For FY 2025-26, the maximum amount is $1,137,678 and will be included in the BHRS FY 2025-26 Recommended Budget. Of this amount, $967,026 will be funded by Medi-Cal Reimbursement, and $170,652 will be funded by 2011 Realignment. There is no Net County Cost.
BHRS is changing the methodology used to pay contracted providers that are currently paid on a 1/12th, monthly advance. Specifically, BHRS is changing the payment methodology for most contracts to fee-for-service and payments will be made in arrears. Additionally, in previous fiscal years, BHRS was granted an exception to pay providers during the accounting “blackout period” in July and August. This exception will no longer be available.
To facilitate these changes, BHRS has agreed to one three-month pre-pay for July-September of FY 2025-26 to qualifying providers. This payment will be reconciled in November. This payment must be made in June 2025. However, to make this payment, an ATR is needed. One ATR for all the impacted contracts will be submitted on the May 22, 2025, Board agenda. There will be no pre-pays in subsequent fiscal years.